Portal annular pancreas: the pancreatic duct ring sign on MRCP (original) (raw)
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Portal Annular Pancreas: Case Report of a Rare Anomaly
Cureus
Portal annular pancreas is a rare congenital anomaly in which the portal vein and/or the splenoportal confluence are completely encircled by aberrant pancreatic parenchyma. It is an asymptomatic condition and is usually an incidental finding. It is, however, important to a surgeon because the postoperative pancreatic fistula (POPF) rates following pancreatic resection are higher in patients with this anomaly. A 47-year-old male presented with features of obstructive jaundice. He was diagnosed to have periampullary carcinoma, and pancreatoduodenectomy was planned. During surgery, uncinate process was seen extending posterior to the portal vein and was communicating with the body of pancreas to the left of the portal vein. After transection, there were two pancreatic stumps. The pancreatic duct was identified in the stump anterior to the portal vein. No duct was present in the posterior pancreatic stump. We closed the posterior pancreatic stump with interrupted polypropylene sutures and performed a duct to mucosa pancreaticojejunostomy in the anterior stump. On reviewing the preoperative computed tomography (CT) scan, we were able to identify the pancreatic tissue encasing the portal vein superior to the splenic vein. Circumportal pancreas is classified based on the orientation of pancreatic duct to the portal vein and the relationship of the aberrant pancreatic tissue with the splenoportal confluence. Following pancreatoduodenectomy, the surgeon has to manage two pancreatic stumps, one anterior and the other posterior to the portal vein. No standardised technique has been described for management of the pancreatic stumps. Every surgeon planning pancreatic surgery should be aware of this rare anomaly, and look for the same in the preoperative CT scan so that appropriate plan can be made regarding the type of pancreatic anastomosis.
Surgery, 2009
PORTAL ANNULAR PANCREAS (PAP) is a pancreatic anomaly in which the uncinate process of the pancreas extends and fuses to the dorsal surface of the body of the pancreas by surrounding the portal vein. To the best of our knowledge, there have only been 3 reports of PAP in the literature. 1-3 During pancreatic resection, the presence of a PAP significantly affects the procedure, including the pancreaticointestinal reconstruction. Thus, it is important to recognize a PAP preoperatively; however, the frequency and characteristics of the anomaly have yet to be precisely determined. Our experience of technical difficulty during a pancreaticoduodenectomy in a patient with a PAP and distal bile duct adenocarcinoma led us to determine the frequency of PAP and its morphologic features. To this end, we reviewed abdominal contrast-enhanced multidetector computed tomographies (MDCTs) to determine the incidence of PAP. . The 700
Portal Annular Pancreas: A Rare and Overlooked Anomaly
Polish Journal of Radiology, 2017
Portal annular pancreas is a rare pancreatic developmental anomaly which is often overlooked at imaging, and often diagnosed retrospectively when it is detected incidentally at the time of surgery. Although the anomaly itself is asymptomatic, it becomes important in cases where pancreatic resection/anastomosis is planned, because of varying ductal anatomy, risk of ductal injury and increased risk of postoperative pancreatic fistula formation.
Unusual clinical presentation of annular pancreas in the adult
Pancreatology, 2005
Annular pancreas (AP) is a rare congenital anomaly, usually present in childhood, with symptoms due to duodenal obstruction; however, this condition can manifest in adulthood with abdominal pain, pancreatitis and pancreatic head mass. The authors present a case of AP observed in a 22-year-old patient that presented an unusual dual-phase clinical manifestation of duodenal obstruction in infancy that was treated by a duodenojejunostomy, and abdominal pain due to chronic pancreatitis in the adult age. MRI with cholangiopancreatography played a decisive role in achieving the correct diagnosis. The patient was treated by a pylorus-preserving Whipple procedure, with resection of the previous duodenojejunostomy. Pancreatic changes characteristic of chronic pancreatitis were demonstrated both in the AP and in the resected pancreatic segment. A marked biliopancreatic ductal anomaly not previously described in the literature was demonstrated by radiologic examination of the surgical specimen. The pathogenesis of AP, the importance of its association with benign and malignant pancreatic disease and the treatment alternatives are discussed by the authors.
Radiology and Oncology, 2016
Background The study was conducted to evaluate the frequencies of the anatomic variations and the gender distributions of these variations of the pancreatic duct and their relevance with the Cambridge classification system as morphological sign of chronic pancreatitis using magnetic resonance cholangiopancreatography (MRCP). Patients and methods We retrospectively reviewed 1312 consecutive patients who referred to our department for MRCP between January 2013 and August 2015. We excluded 154 patients from the study because of less than optimal results due to imaging limitations or a history of surgery on pancreas. Finally a total of 1158 patients were included in the study. Results Among the 1158 patients included in the study, 54 (4.6%) patients showed pancreas divisum, 13 patients (1.2%) were defined as ansa pancreatica. When we evaluated the course of the pancreatic duct, we found the prevalence 62.5% for descending, 30% for sigmoid, 5.5% for vertical and 2% for loop. The most com...
Circumportal Pancreas - A Rare Case
American Journal of Health, Medicine and Nursing Practice
Circumportal pancreas is a rare anatomical variant in which anomalous pancreatic parenchyma entirely encircles the portal vein. A 60 years old female presented to us for CT enteroclysis with complaint of diffuse abdominal pain. Infrasplenic circumportal pancreas with anteportal pancreatic duct was reported, which is an incidental finding. It presents a diagnostic challenge for a radiologist because misinterpretation of circumportal pancreas as a pancreatic head mass can have a significant impact on clinical outcomes i.e. postoperative pancreatic fistula and can help surgeon to plan better approach for pancreatectomies.
A Classic Case of Annular Pancreas and its Clinical Implications
International Journal of Morphology, 2011
Annular pancreas is a rare developmental anomaly where the head of the pancreas surrounds the second part of the duodenum like a ring. This may cause the duodenal constriction, obstruction, peptic ulcers and other complications. We saw a classic case of annular pancreas. The head of pancreas surrounded the second part of duodenum completely. However there was no narrowing of the duodenum. The case may be of importance for gastroenterologists, surgeons and radiologists.